Psychological stress and short-term hospitalisations or death in patients with heart failure

Romano Endrighi, Andrew J. Waters, Stephen S. Gottlieb, Kristie M. Harris, Andrew Wawrzyniak, Nadine S. Bekkouche, Yisheng Li, Willem J. Kop, David S. Krantz

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective Standard predictors do not fully explain variations in the frequency and timing of heart failure (HF) adverse events (AEs). Psychological stress can trigger acute cardiovascular (CV) events, but it is not known whether stress can precipitate AEs in patients with HF. We investigated prospective associations of psychological stress with AEs in patients with HF. Methods 144 patients with HF (77% male; 57.5 ±11.5, range 23-87 years, left ventricular ejection fraction ≤40%) were longitudinally evaluated for psychological stress (Perceived Stress Scale) and AEs (CV hospitalisations/death) at 2-week intervals for 3 months and at 9-month follow-up. Results 42 patients (29.2%) had at least one CV hospitalisation and nine (6.3%) died. Patients reporting high average perceived stress across study measurements had a higher likelihood of AEs during the study period compared with those with lower stress (odds ratio=1.10, 95% confidence interval=1.04 to 1.17). In contrast to average levels, increases in stress did not predict AEs ( p=0.96). Perceived stress was elevated after a CV hospitalisation (B=2.70, standard error (SE)=0.93, p=0.004) suggesting that CV hospitalisations increase stress. Subsequent analysis indicated that 24 of 38 (63%) patients showed a stress increase following hospitalisation. However, a prospective association between stress and AEs was present when accounting for prior hospitalisations (B=2.43, SE=1.23, p=0.05). Conclusions Sustained levels of perceived stress are associated with increased risk of AEs, and increased distress following hospitalisation occurs in many, but not all, patients with HF. Patients with chronically high stress may be an important target group for HF interventions aimed at reducing hospitalisations.

Original languageEnglish (US)
JournalHeart
DOIs
StateAccepted/In press - Jun 29 2016

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Psychological Stress
Hospitalization
Heart Failure
Stroke Volume
Odds Ratio
Confidence Intervals

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Endrighi, R., Waters, A. J., Gottlieb, S. S., Harris, K. M., Wawrzyniak, A., Bekkouche, N. S., ... Krantz, D. S. (Accepted/In press). Psychological stress and short-term hospitalisations or death in patients with heart failure. Heart. https://doi.org/10.1136/heartjnl-2015-309154

Psychological stress and short-term hospitalisations or death in patients with heart failure. / Endrighi, Romano; Waters, Andrew J.; Gottlieb, Stephen S.; Harris, Kristie M.; Wawrzyniak, Andrew; Bekkouche, Nadine S.; Li, Yisheng; Kop, Willem J.; Krantz, David S.

In: Heart, 29.06.2016.

Research output: Contribution to journalArticle

Endrighi, R, Waters, AJ, Gottlieb, SS, Harris, KM, Wawrzyniak, A, Bekkouche, NS, Li, Y, Kop, WJ & Krantz, DS 2016, 'Psychological stress and short-term hospitalisations or death in patients with heart failure', Heart. https://doi.org/10.1136/heartjnl-2015-309154
Endrighi, Romano ; Waters, Andrew J. ; Gottlieb, Stephen S. ; Harris, Kristie M. ; Wawrzyniak, Andrew ; Bekkouche, Nadine S. ; Li, Yisheng ; Kop, Willem J. ; Krantz, David S. / Psychological stress and short-term hospitalisations or death in patients with heart failure. In: Heart. 2016.
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abstract = "Objective Standard predictors do not fully explain variations in the frequency and timing of heart failure (HF) adverse events (AEs). Psychological stress can trigger acute cardiovascular (CV) events, but it is not known whether stress can precipitate AEs in patients with HF. We investigated prospective associations of psychological stress with AEs in patients with HF. Methods 144 patients with HF (77{\%} male; 57.5 ±11.5, range 23-87 years, left ventricular ejection fraction ≤40{\%}) were longitudinally evaluated for psychological stress (Perceived Stress Scale) and AEs (CV hospitalisations/death) at 2-week intervals for 3 months and at 9-month follow-up. Results 42 patients (29.2{\%}) had at least one CV hospitalisation and nine (6.3{\%}) died. Patients reporting high average perceived stress across study measurements had a higher likelihood of AEs during the study period compared with those with lower stress (odds ratio=1.10, 95{\%} confidence interval=1.04 to 1.17). In contrast to average levels, increases in stress did not predict AEs ( p=0.96). Perceived stress was elevated after a CV hospitalisation (B=2.70, standard error (SE)=0.93, p=0.004) suggesting that CV hospitalisations increase stress. Subsequent analysis indicated that 24 of 38 (63{\%}) patients showed a stress increase following hospitalisation. However, a prospective association between stress and AEs was present when accounting for prior hospitalisations (B=2.43, SE=1.23, p=0.05). Conclusions Sustained levels of perceived stress are associated with increased risk of AEs, and increased distress following hospitalisation occurs in many, but not all, patients with HF. Patients with chronically high stress may be an important target group for HF interventions aimed at reducing hospitalisations.",
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AU - Endrighi, Romano

AU - Waters, Andrew J.

AU - Gottlieb, Stephen S.

AU - Harris, Kristie M.

AU - Wawrzyniak, Andrew

AU - Bekkouche, Nadine S.

AU - Li, Yisheng

AU - Kop, Willem J.

AU - Krantz, David S.

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N2 - Objective Standard predictors do not fully explain variations in the frequency and timing of heart failure (HF) adverse events (AEs). Psychological stress can trigger acute cardiovascular (CV) events, but it is not known whether stress can precipitate AEs in patients with HF. We investigated prospective associations of psychological stress with AEs in patients with HF. Methods 144 patients with HF (77% male; 57.5 ±11.5, range 23-87 years, left ventricular ejection fraction ≤40%) were longitudinally evaluated for psychological stress (Perceived Stress Scale) and AEs (CV hospitalisations/death) at 2-week intervals for 3 months and at 9-month follow-up. Results 42 patients (29.2%) had at least one CV hospitalisation and nine (6.3%) died. Patients reporting high average perceived stress across study measurements had a higher likelihood of AEs during the study period compared with those with lower stress (odds ratio=1.10, 95% confidence interval=1.04 to 1.17). In contrast to average levels, increases in stress did not predict AEs ( p=0.96). Perceived stress was elevated after a CV hospitalisation (B=2.70, standard error (SE)=0.93, p=0.004) suggesting that CV hospitalisations increase stress. Subsequent analysis indicated that 24 of 38 (63%) patients showed a stress increase following hospitalisation. However, a prospective association between stress and AEs was present when accounting for prior hospitalisations (B=2.43, SE=1.23, p=0.05). Conclusions Sustained levels of perceived stress are associated with increased risk of AEs, and increased distress following hospitalisation occurs in many, but not all, patients with HF. Patients with chronically high stress may be an important target group for HF interventions aimed at reducing hospitalisations.

AB - Objective Standard predictors do not fully explain variations in the frequency and timing of heart failure (HF) adverse events (AEs). Psychological stress can trigger acute cardiovascular (CV) events, but it is not known whether stress can precipitate AEs in patients with HF. We investigated prospective associations of psychological stress with AEs in patients with HF. Methods 144 patients with HF (77% male; 57.5 ±11.5, range 23-87 years, left ventricular ejection fraction ≤40%) were longitudinally evaluated for psychological stress (Perceived Stress Scale) and AEs (CV hospitalisations/death) at 2-week intervals for 3 months and at 9-month follow-up. Results 42 patients (29.2%) had at least one CV hospitalisation and nine (6.3%) died. Patients reporting high average perceived stress across study measurements had a higher likelihood of AEs during the study period compared with those with lower stress (odds ratio=1.10, 95% confidence interval=1.04 to 1.17). In contrast to average levels, increases in stress did not predict AEs ( p=0.96). Perceived stress was elevated after a CV hospitalisation (B=2.70, standard error (SE)=0.93, p=0.004) suggesting that CV hospitalisations increase stress. Subsequent analysis indicated that 24 of 38 (63%) patients showed a stress increase following hospitalisation. However, a prospective association between stress and AEs was present when accounting for prior hospitalisations (B=2.43, SE=1.23, p=0.05). Conclusions Sustained levels of perceived stress are associated with increased risk of AEs, and increased distress following hospitalisation occurs in many, but not all, patients with HF. Patients with chronically high stress may be an important target group for HF interventions aimed at reducing hospitalisations.

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